IBM helps hospital with ER treatment

"People don't come to us to go through patient registration," said Broderick, chairman of emergency medicine at Danbury Hospital. "They come to see a doctor."

Now, thanks to a collaboration between IBM and Danbury Hospital, Broderick and his colleagues have cut repetition, re-assigned staff and begun to streamline how they treat patients.

The collaboration - the first of its kind between IBM and an emergency department in the United States - has already begun to cut steps away from how the department treats its patients. More changes will come within the next two years, as the department forsakes written orders and wall charts for a completely computerized system to track patients.

"We are absolutely thrilled with the results," said Dr. Mikelle Streicher, of IBM's Health Care Provider Clinical Transfer unit and project manager on the Danbury effort. "We are thrilled with Danbury Hospital and we are thrilled to be able to demonstrate this system can improve patient safety and at the same time, help a hospital's finances."

Broderick said about two years ago, his department began to redouble its efforts to improve patient satisfaction.

"It's not that we were dissatisfied with what we were doing," he said. "It's that we saw an opportunity for change."

Emergency department staff tried to cut down on long waits and make sure patients had little amenities like an extra blanket or a cup of coffee. The staff also strove to keep everyone - patient and family members alike - informed of the patient's medical conditions

"You're not going to make everyone happy, but you try," Broderick said. "With the few patients that aren't happy, you try to learn something about doing things in a better way."

So, when IBM approached the emergency department in 2004 to discuss setting up a pilot program there, the hospital readily agreed.

The IBM team arrived at the hospital last year. Working for 10 weeks, it examined the department patient data and ran simulations to find out how things might be done better. In general, Broderick said, doing things more efficiently also means doing them more safely.

"Every time there's a different step in a patient's care, there's an opportunity for error," he said. "If you can reduce a step or two, you can reduce errors."

Streicher said the hospital, which now treats about 65,000 patients a year, could increase that number to 72,000 as it cuts out repetition and unneeded work.

One of the ways the hospital learned it could speed patient care is to get them onto a bed and under medical care first, then register them later. This means setting up a portable registration system that can move from patient to patient.

Broderick said eventually, this will become standard operating procedure for all patients.

"If someone comes into the department at 9 a.m. with a sprained ankle, and there's a bed open, I want us to take that patient back and begin treatment, then register them," he said.

Another simple adjustment, Broderick said, was to realize that the department's triage nurse - the person in charge of evaluating patients and deciding who needs immediate attention and who can wait - was overburdened during peak hours. Simply by shifting extra staff there, he said, the department improved the speed in which patients move through the system.

Streicher said IBM also urged the hospital to improve its capacity management - the speed in which it is able to admit a patient once the emergency staff deems the patient to ill too go home.

"We've all heard of patients lying in an emergency department for hours because a bed wasn't available upstairs," Broderick said. "We want to reduce that wait when we can."

The hospital spent about $100,000 on the collaboration with IBM, Broderick said, with IBM contributing much more in order to set up the model program.

"It probably cost us 20 percent of the total cost," he said.

The next step could cost the hospital $500,000 or more. IBM recommended that the department install an Emergency Department Information System, or EIDS. Broderick said the hospital will begin to look at the different systems available this year, and have one operating by 2006.

With such a system, all patient records would be computerized from the start. Broderick said such a system has many advantages. Instead of doctors and nurses having to share charts, everyone can look at the records via computer at the same time.

It would also allow the staff to have the most up-to-date information at its fingertips.

Some of the measures have already pleased the department's patients. A recent survey by Press Ganey Associates, a national health survey and evaluation firm, showed 99 percent of the department's patients were satisfied with their care there; the previous Press Ganey report showed only a 67 percent satisfaction rate.

"We want to get the patient to treatment faster and more efficiently," Broderick said. "We also want to treat them like they are members of our own families.''